Long Covid fatigue and overdoing

I’ve been reading journal articles about Long Covid. The three primary symptoms are fatigue, shortness of breath and brain symptoms. Mostly brain fog. Then there is a long long list of other symptoms.

For the fatigue, the journals are recommended graded increase in activity “without triggering a fatigue crash”.

Now, that is all well and good, except it’s a moving target. The amount of activity one can do is NOT static.

I have something that caused CFS-ME. My fast twitch muscles came back on line sometime between Christmas and New Years. GREAT! Then I was helping a sick friend until January ninth. I flew home and then there is all the unpacking and bills and catching up and sweeping up catfur dust elephants. Finally I got to exercise. I walked a couple miles on the beach one day and then around town with a friend the next.

Which crashed me. The third day I spent lying on the couch. My muscles basically were ALL hurting and saying, “We hate you.”

The fast twitch are back on line but they are weak as newborn kittens. For the first two days I felt strong and normal. The third day I felt like a steamroller had gone over me.

So did I do the wrong thing? Well, no. I won’t know what I can and can’t do it unless I do it, right? After four rounds (or more) of pneumonia with muscle weirdness, I can tell when it’s improving. Then I have to rebuild the working muscles. Also my slow twitch posture muscles are frankly pissed off and have been doing all the work and are not very interested in working with the fast twitch when they first come on line. “Where have YOU been? We’ve been doing YOUR work AND OURS.” I have to learn to walk again.

I was doing well with pulmonary rehab in the fall, building up on the treadmill twice a week, until I got my flu shot and then my Covid booster. Well, they are supposed to raise antibodies. Unfortunately they raised the ones that make my fast twitch muscles not work. Muscle blocker antibodies. I am just glad that my slow twitch work, because I sympathize hugely with the people who end up lying in bed. It’s still inconvenient, difficult to explain and annoying.

At any rate, gentle graded increase in activity is all very well as advice. But do you control everything that happens in your life? I don’t. Someone gets sick, the mail goes awry, a billing company changed their address and I didn’t get the memo. It all takes energy. Some days I am going to overdo, especially when I feel better. And it rather sucks to lie around the next day, but it is ok.

Over the last week I had a friend up from Portland. We walked three days running. On the third day we walked paths from my house to the lighthouse and back. About 5-6 miles. I was not quite limping when I got home, but I knew I could rest the next day. My muscles got HUNGRY and are continuing to improve.

So when your doctor tells you “graded activity to avoid fatigue crashes”, remember that it is not wholly controllable because life is not wholly controllable. Some days you will do great and others, well, hmmm. That was too much.

Blessings.

https://www.aafp.org/pubs/afp/issues/2022/1100/long-covid.html

https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html

Exercise mets

Mets could be metastases, a terrible word in cancer. But this is exercise mets. I am half way through my pulmonary rehabilitation for pneumonia and getting stronger. So what is a met? “One MET is approximately 3.5 milliliters of oxygen consumed per kilogram (kg) of body weight per minute.” (from https://www.healthline.com/health/what-are-mets#definition).

Ok, that doesn’t seem very useful. I find this way more useful, a chart of how many mets are used for certain activities:

https://www.healthline.com/health/what-are-mets#examples

The treadmill I am using at pulmonary rehab tells me how many mets I am using. However, last time I turned it on and didn’t enter my weight. It uses 155 pounds, which is more than I weigh. I think that then the mets are wrong. It isn’t exact anyhow. The important thing is that I am improving and off oxygen! I am now up to 5.3 mets, going at 3.3 mph, on a 4% grade, for 40 minutes. Pulmonary rehab is twelve weeks, twice a week, with a respiratory therapist and a physical therapist.

My respiratory therapist asks my goals. To bicycle distance, hike across the Olympics, and to ski again, off oxygen. That means altitude. Once we are above 5500 feet, the body really starts noticing the thinner air. I am not there yet but I am so pleased to be improving.

On the chart, I am in the moderate exercise range. To bicycle, I would have to be able to sustain 8 mets. Not yet, not yet.

Being off oxygen (except night, flute, sustained singing and heavy exercise) is GREAT! The intrinsic problem has not been fixed, thought. Fully twenty specialists since 2012 have not figured out why I get pneumonia easily and how to protect me, other than masking and not working in Family Medicine or anything people intensive. It’s annoying, my career has been blown up. I don’t have much hope of an overarching diagnosis at this point, but I’m willing to keep trying. We don’t know everything in medicine and really, I do not think we ever will. It’s endlessly complex and fascinating.

I think the mets chart should be shared with patients. I had one couple who insisted that the woman had PMS even though she was postmenopausal. I scratch my head and continue to watch her. After months something made me suspicious and I order an echocardiogram. She had congestive heart failure, seriously reduced heart output. I promptly called the cardiologist and said, “This is new, she is on NO MEDICINES.” He saw her within a week. Sometimes things do not present in a straight forward manner. She felt much better once we got her heart functioning better. If a person is losing their ability to perform moderate intensity mets, they should see their doctor. It could be spending too many hours in front of a screen (turn it off, get up, go outside, walk daily!) but it could also be something else. Heart is the number one killer still.

Stay healthy and keep those mets up!

Ha. I did use the word certain, didn’t I? And one of my favorite exercises is dancing. Listening to this right now:

rest

For the Ragtag Daily Prompt: exercise.

I have not been exercising this week, since Monday. I have barely left the house! but influenza is like that and it’s a time to rest.

I photographed this pair of American wigeons napping last weekend, at Kai Tai Lagoon in the sun. Napping in the water, how clever, I can’t do that. I do think I woke them, but at least one returned to sleep. Hopefully I’ve learned my lesson in the past too. I have to rest when I am sick and return to exercise afterwards!

A pair of American wigeons, on the water, female asleep and male awake.


E for Envy

E for envy. Envy is the second of the 7 sins. Perhaps a sin, but we are all human. I think that we all have the full spectrum of feelings. It is not a matter of refusing to feel something: that does not work well. My minister speaks of when we feel very virtuous and raised up, that is when we are most in danger of treating others badly, and he quotes Luke.

Luke 11:43 “Now when the unclean spirit goes out of a man, it passes through waterless places seeking rest, and does not find it. 44″Then it says, ‘I will return to my house from which I came’; and when it comes, it finds it unoccupied, swept, and put in order. 45″Then it goes and takes along with it seven other spirits more wicked than itself, and they go in and live there; and the last state of that man becomes worse than the first. That is the way it will also be with this evil generation.”

Is the unclean spirit a feeling that we think is a sin or a feeling we interpret as bad or evil? That could be one interpretation.

In contrast, Mewlana Jalaluddin Rumi in The guesthouse says:

Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
As an unexpected visitor.
Welcome and entertain them all!

And why welcome and entertain them all?

Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.

Be grateful for whoever comes,
because each has been sent
as a guide from beyond.

—–translation by Coleman Barks

So: envy

noun, plural envies.
1. a feeling of discontent or covetousness with regard to another’s advantages, success, possessions, etc.
2. an object of such feeling:
Her intelligence made her the envy of her classmates.
3. Obsolete. ill will.
verb (used with object), envied, envying.
4. to regard (a person or thing) with envy: She envies you for your success. I envy your writing ability.
He envies her the position she has achieved in her profession.

E

I did Gallery Walk in our downtown on Saturday. We are blessed with artists and there were many pieces that I liked. I did not buy any. I ended up in a small shop with singing bowls. The owner sells them but he also has a set that he keeps. He started to play the bowls, each on it’s small cushion. I have three bowls, smaller ones, that I have bought over the years. I love the ring and the resonance and the held note. But I learned something new: he used the felted end of the mallet and could make the bowl sing another way. I have never seen this before. Some bowls sing a different note with the felt. I covet the large deep bowls: I bought the largest one I could afford five years ago. But his are gorgeous in sound. I looked at a price tag. Ten times the cost of the one I bought.

He also explained that different notes are used for healing and for the different chakras. The size and the thickness of the bowl affects the note, whether it is high or low, whether it rings. The metal affects it as well and he has a bowl with meteorite. A full set would be seven, though many people use sets of three that sing together.

I bought mine separately, so I came home to try whether any would sing with felt and whether they are tuned to each other. They are tuned, but I cannot make them sing with the felt yet. I will take them to him for a lesson…. I am envious of his bowls….

And the photo is my daughter, at the end of a twelve mile mountain bike race Sunday. She does not even look tired! I am envious of how in shape she is: she swims three to five miles six days a week during swim season and exercises most days. I am just starting to build back up, but I am unlikely to catch up with her! Envy… I am hoping that it will motivate me to exercise more….

Exercise the wanting self

Achy this morning

Busy on Monday
Virus on Tuesday
Throwing up and
cancelled clinic
Beloved visitors all week
Worked, nauseated Wednesday
Thursday almost better
Evening festive
But up 1 to 4 am
with someone way too sick
phone to specialists
six times
finally I tell her
if she is not transferred
I think she will die
She chooses to go
Slightly groggy clinic Friday
Hard to type

Achy on Saturday

I make myself
go to the pool
to swim laps
I know
it will help

In the water
the wanting self
is noisy
I want goggles
I am wearing a mask
It leaks
Why haven’t I gotten goggles
I deserve them
Moratorium on spending
currently
and haven’t had time
and I want that
beginner yoga kit
and other things

The wanting self
makes me tired
and it is silly
to want so much
Stymied, the wanting self
goes on about work
I am on lap number twelve
I think
I am uncomfortable
with Mr. J in clinic
who keeps wanting
more pain medicine
and complains about
my boundaries
In the water
I realize
that he is no more comfortable with me
than I with him
I am pleased
to admit that
and can refer him
to a pain clinic
The lady next to me
has a powerful breast stroke
long deep glide
under the water
The wanting self
wants to swim like her
Why don’t I exercise more often?
I am lazy
Maybe I will exercise
before my first cup of tea
every morning
The wanting self
builds castles in the water
plans
that wash away
I wonder if the wanting self
builds up
is stored
in my muscles
and exercise
exorcises
the wanting self
That would explain
fibromyalgia
better than anything
I know of
and why exercise
is the best treatment
and maybe that is why
exercise
and exorcise
are so close
I picture all our
wanting selves
sloshing around the pool
released
they dissipate
Does chlorine
inhibit their return
to our bodies?
We climb sleek
from the pool
and shower

I am less achy
still tired
but my muscles feel
polished
pumped
blood flow
has returned

I must exercise
more often
and exorcise
the wanting self